<!DOCTYPE html>
<html>
  <head>
    <meta charset="UTF-8">
    <title></title>
  </head>
  <body>
    <form action="http://www.google.com/" method="post">
      <label for="ln">Nachname:</label> <input type="text" id="ln"><br>
      <label for="fn">Vorname:</label> <input type="text" id="fn"><br>
      <label for="cm">Firmenname:</label> <input type="text" id="cm"><br>
      <label for="a1">Straße und Hausnummer:</label> <input type="text" id="a1"><br>
      <label for="a2">Adresszusatz:</label> <input type="text" id="a2"><br>
      <label for="ct">Stadt:</label> <input type="text" id="ct"><br>
      <label for="zc">Postleitzahl:</label> <input type="text" id="zc"><br>
      <label for="st">Land:</label> <input type="text" id="st"><br>
      <label for="em">E-Mail-Adresse:</label> <input type="text" id="em"><br>
      <label for="ph">Telefonnummer:</label> <input type="text" id="ph"><br>
      <label for="c1">Karteninhaber:</label> <input type="text" id="c1"><br>
      <label for="c2">Kartennummer:</label> <input type="text" id="c2"><br>
      <label for="c3">gültig bis monat:</label> <input type="text" id="c3"><br>
      <label for="c4">gültig bis jahr:</label> <input type="text" id="c4"><br>
    </form>
  </body>
</html>